That's one huge leap to suggest Relafen is superior to Tamoxifen based on a few PREPUBERTAL STUDIES!
Although Raloxifene maybe more effective than Tamo, in select patients, a cost of somewhere between $150- $250 dollars per month would preclude it's use on a routine basis for AAS associated cyclical gynecomastia.
Tamo is equally effective for ASS associated gynecomastia in the majority of patients, especially if some attempts are made at reducing the load of aromatizable AAS from the outset.
Importantly it's important to realize studies using "prepubertal gynecomastia" patients as the cohorts, although helpful to some extent, should be taken with a grain of salt since this condition reverses spontaneously in more than 95% of patients, which is in contradistinction to AAS related disease.
Moreover the comparison or concern that ANY SERM will cause bony demineralization if used over the course of a few months (as in AAS) or years (as in breast cancer) is simply not justifiable.
Furthermore the Raloxifene has actually been utilized as a form of therapy in PMP patients with osteoporosis because it's effect on BMD is minimal and possibly even PROTECTIVE
Overall although I suspect Raloxifene may be superior to other SERMs in the TX of gynecomastia, it's use should be limited to resistant cases if not for cost alone!
As JI mentioned although SERMS may result in a reduction of pre-existing gynecomastia. there IS NO EVIDENCE any SERM causes or results in cellular necrosis or apoptosis, which would be required for the therapeutic reversal to be long lasting or "permanent" (SEVERAL YEARS) as some
have claimed.
What does that mean? Fellas if you have had problems with gynecomastia previously (and have NOT had surgery for same) a SERM should be instituted BEFORE the inception of that cycle your contemplating and since the half life averages about 3 DAYS, treatment should begin at least TWO WEEKS (5 half lives) prior!!!!
The lack of a "long term" effect from SERMS should be of no surprise since a marked reduction in cellular reproduction is exactly what has been observed in PMP E-2 dependent patients treated with SERMS, rather than cellular death.
One final point of EMPHASIS must be made!
At LEAST TWO WEEKS of SERM treatment should have passed before a therapeutic failure is declared and the dose adjusted accordingly.
